शैडोइंग अभ्यास: Headache History | OSCE Guide | UKMLA | CPSA | PLAB 2 - YouTube के साथ अंग्रेजी बोलना सीखें

Hello, my name's Jade, I'm one of the doctors.

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Hello, my name's Jade, I'm one of the doctors.

Hi.

Could I just take your name and date of birth, please?

Yeah, it's Eve Pollack.

It's the second or the third, 1990.

Okay, that's great.

Thanks, Eve.

What's brought you in today?

I've been suffering from really severe headaches recently.

Okay, could you tell me a bit more about the headaches?

Yeah, just very painful, really debilitating to be honest

and I'm getting a bit worried about them now so I just wanted to come and have a chat about it.

Yeah, understandable.

So how long have these headaches been going on for?

It's been about six months in total now.

Okay, so quite a while.

And whereabouts do you feel the headaches?

It's usually just on one side of my head.

It can be left or right but it's just on that one side.

Okay, and what does it feel like?

I describe it as sort of like a really kind of deep sort of throbbing,

you know, like a pounding type of headache.

Yeah, so when the headache comes on,

is it all of a sudden or does it gradually build up?

It sort of gradually comes on

and then I'd say over a period of sort of minutes it kind of gets worse and until it,

yeah, it's very painful and then it kind of stays like that for the rest of the time.

How long does the headache tend to last?

Oh, hours.

It can be all day,

all night to the point where I just have to try and get myself off to sleep to make it go away.

Okay.

And does the pain move anywhere else?

No, it just stays on the one side.

Okay.

And do you ever get any other symptoms alongside the headache?

Yeah, when I've got the headache,

I tend to feel quite sick with it.

Okay.

Have you ever been sick with it?

No, I've never been sick.

I just feel really nauseous.

Have you ever experienced any sort of stiffness in your neck with the headache?

No. Okay.

And is there any particular times you've noticed the headache coming on?

I've noticed a couple of times it's been when I've been particularly tired from work or maybe a little bit stressed.

And there's also been a couple of times where it's sort of happened at the start of my period.

Okay, how frequently do you think they're happening?

The headaches are probably once or twice a month.

Once or twice a month, okay.

Any particular time of day it tends to occur?

Probably mostly afternoons, I would say,

maybe when I finish work,

yeah, that sort of thing.

Okay, and has it ever woken you up in the night or in the morning?

No. Okay, and then, so you said sometimes at the start of your period,

how long is your cycle usually?

28 days.

28 days, okay.

And are you on any contraception?

Yes, I take the mini pill.

The mini pill, okay.

And anything you've noticed that makes headaches worse?

Yeah, kind of bright lights,

loud noises, that sort of thing that just makes it more uncomfortable.

And in terms of other things that might make it worse,

you haven't noticed it's affected by standing up or laying down?

No, it tends to just not make a difference, that sort of thing.

Okay, anything that makes it better?

No, not really.

I tend to just have to go and lie down in a quiet,

dark room and just wait for it to pass.

Have you tried any medications at all?

Just paracetamol and ibuprofen, but I don't really seem to do much.

How often do you tend to take them?

When the headache comes on I'll just take,

you know, maybe try a couple of paracetamol and then a couple of ibuprofen later but as I said,

neither of them seem to work so I've not really taken many.

Okay and

if you had to put on a scale of kind of

0 to 10 where 0 is no pain at all and 10 is the worst pain you've ever felt,

what would you rate the headaches?

Probably 8 out of 10.

I mean at times I'd go so far as to say it was 10 out of 10.

It's really awful.

Yeah, it sounds like they're really really painful.

How has that been impacting your life?

It's just awful in terms of that's sometimes I'm having to wait all day

and all night for it to go away

and that's not what I want to be doing with my days and yeah it's not pleasant it's really debilitating.

Yeah I can imagine.

And then in terms of before the headache do you ever get any symptoms before the headache comes on?

Kind of the day before

I've noticed that I feel really tired and can get a little bit irritable

and I feel like I just spend the day just yawning the day before I get a headache.

Okay and how about immediately before the headache are there any sort of warning signs that's about to come on?

Yeah I tend to see

what I can just describe as kind of like flashing or flickering lights and then just before

I'll get these zigzaggy kind of lines and then I know you know that's it then the headache comes on after that.

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Okay and then you mentioned that with the headache you get a bit of nausea as well.

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Yeah.

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After the headache's passed do you feel kind of back to normal or do you still feel a bit...

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No I tend to feel really washed out after the headache

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really like sort of next day sometimes yeah the next day

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or two I feel really tired yeah quite drained you know it really takes it out of us.

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Okay.

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And have you ever had any fevers?

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No. No. Any changes to your appetite?

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No. Or any changes to your weight?

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No. No. Or have you ever woken up feeling very sweaty at night?

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No. No. Okay.

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And is there anything in particular you thought might be going on?

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I don't know.

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I've never experienced anything like this before.

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So I'm just a bit baffled as to why I'm suddenly suffering from these headaches.

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Yeah.

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And is there anything about it that's really been worrying you?

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Yeah, I am a little bit concerned now because with it being going on for the last six months,

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I'm a little bit concerned that this could be something maybe a bit more sinister.

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and maybe something like a brain tumour.

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Okay, so that sounds like it's been really worrying.

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Yeah.

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Is there anything in particular you were hoping we'd be able to do for you today?

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Just try and find out what's going on really and ideally maybe get some strong painkillers,

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something that will just make the pain go away.

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Yeah, okay.

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I'm just going to run through a few more questions just about your general health.

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Have you got any other medical conditions at all?

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Yeah, I've been diagnosed in the past with depression and anxiety.

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Okay, and how has your mood been with all this going on?

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That's under control.

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I take medication, so I feel like I've been okay.

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Okay, yeah, that's good to hear.

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What medication is it that you're taking?

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Sertraline.

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Sertraline, and how long have you been taking that for?

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Oh, that's probably been a few years now,

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to be honest, yeah, but I'd say that that seems to be working the whole thing here.

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Okay, good.

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So you're on sertraline and then you mentioned the mini pill as well,

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and as well as the paracetamol and ibuprofen when you get the headache.

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Yeah.

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Is there any other medications you take?

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No, that's it.

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No?

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And any allergies at all?

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No. No. Okay, lovely.

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And any conditions that run in the family at all?

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My mum did mention to me that she's suffered from bad headaches in the past.

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Yeah, so she has, she did mention that and she's actually had breast cancer a few years back.

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She's all fine in everything now but yeah,

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that's in terms of family.

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Yeah, okay, glad to hear that she's better now.

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Thank you.

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Did she ever have any investigations for her headaches?

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I don't think so, she never mentioned,

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she just said that she used to get really bad headaches.

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Okay, and I'll just ask a bit about your lifestyle now as well now as well

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so are you working at all yes I'm a dental nurse okay

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and

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and has these headaches had any impact on your work I

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have had to kind of call in get someone to come me last minute

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which isn't again it's not ideal not something that I want to continue

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and so yeah that's a bit of a concern okay

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and are you living with anyone at the moment my boyfriend boyfriend okay

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and do you smoke no

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and do you drink any alcohol yeah i have a drink on a weekend okay

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and what is it

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that you tend to drink um i have a few glasses of wine on a friday

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and saturday night okay

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so in in a week how many glasses of wine would you have usually um say six six yeah

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and what size are the glasses um just like a small kind of standard wine glass i guess okay

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so usually about six standard glasses of wine in one week.

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And just a question we have to ask everybody,

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have you ever taken any recreational drugs?

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No. No, okay lovely, thank you.

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So what I'll do is I'm just gonna kind of summarise what you've told me

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so far and if there's anything else that you think is relevant

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or you want to add in then just let me know okay.

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So the main problem you've come in with today is these headaches

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which have been going on for the past six months or

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so and they tend to be on one side of your head

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but it can be either the left side or the right side.

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It's kind of a deep throbbing pain but it doesn't move anywhere

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and you often get a bit of nausea with it as well but you haven't been sick.

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They tend to occur a couple of times a month

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and you've noticed it may be related to when you've not slept properly,

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when you've got a lot of stress or potentially at the beginning of your menstrual cycle as well.

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In terms of things that make it better you've tried kind of paracetamol ibuprofen

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but they don't tend to help you just have to go lie down in a room in the dark

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and things that make it worse,

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so bright lights and loud noises as well.

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And it's been kind of usually an 8 out of 10,

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but at its worst, a 10 out of 10,

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which has meant it's had quite a significant impact on your life.

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It is debilitating and impacted you at work as well.

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And then your main worry was about whether this could be something more sinister.

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So you're just hoping to find out what the headaches could be caused by

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if there's any extra medications we could give you.

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Is that right?

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Yeah, that's right.

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Is there anything else you'd like to add?

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No. No, and is there any other questions that you've got for me today?

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No, I don't think so.

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Okay, well thank you very much for speaking to me.

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Thank you.

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Today I spoke to Eve,

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a 34 year old lady presenting with headaches.

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Eve described a unilateral headache with gradual onset building up over a few minutes that can last hours or even days.

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Eve described the day before the headache feeling tired and irritable with excessive yawning.

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Immediately prior to the headache she described some visual disturbances.

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The headache itself could last hours and is associated with some nausea but no vomiting.

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These headaches typically occur one to two times a month.

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The timing of the day can vary but are typically in the afternoon or evening.

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Eve has also noticed that the headaches can be associated with the beginning of her menstrual cycle.

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The headaches can also be made worse by bright lights and loud noises.

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She has tried using medications such as paracetamol and ibuprofen,

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but has not found any benefit from this.

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Eve described the pain as debilitating,

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often an 8 out of 10,

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but sometimes 10 out of 10.

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This has had a significant impact on her life and she has occasionally had to miss work as a result.

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Eve has a past medical history of depression,

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which is well controlled using sertraline.

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Her only other regular medication is the progesterone only pill and she takes over-the-counter paracetamol and ibuprofen occasionally.

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Eve does not smoke.

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She drinks six small glasses of wine a week.

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She does not take any recreational drugs.

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Eve currently works as a dental nurse and lives with her boyfriend.

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Eve is unclear why she has been getting these headaches as she has never suffered from them before

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and she is worried that there may be something sinister underlying it such as a brain tumour.

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She would like to find out what the cause of the headaches are

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and see if there are any additional painkillers that may be beneficial.

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To complete my assessment I would perform a full neurological and cardiovascular examination and consider further investigations including a headache diary.

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236

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